What to Expect After Foot & Ankle Surgery
Many times surgery is as much an art as it is a science. During any given week we may be performing a bunion surgery for an elderly man with a heart condition who can not wear his shoes comfortably, to a thirty year old executive who wears heels daily, to a high level athlete who demands a quick and thorough recovery. The great majority of procedures we perform are completed on an out-patient basis. Most patients will spend about an hour in the recovery room and then are released to home. Some surgical procedures require a general or spinal anesthesia, however, most procedures are performed under conscious sedation with local anesthesia at a local surgery center or hospital. With this anesthesia you will not feel any pain, you will not remember anything, and you will generally feel very good immediately after the procedure.
Bunion Surgery (Bunionectomy)
Austin Bunionectomy (Most common bunionectomy procedure)
Great Toe Joint Implant (Hemi-Implant or Total Implant)
Great Toe Joint Arthritic Bone Spur Removal (Cheilectomy)
Hammertoe Surgery (Arthroplasty or Arthrodesis)
Tailors Bunion (Bunionette) Surgery
Metatarsal Osteotomy (Weil Osteotomy)
Excision of Interdigital Neuroma
Excision of Ganglionic Cyst
Forefoot surgery has the advantage that most patients can immediately bear weight on their foot. Most patients will receive a post-op shoe (the ugly black sandal with Velcro straps you will see many of our patients wearing!) in the recovery room. This shoe assists in putting weight on your heel. It also prevents you from bending your foot while walking. It forces you to walk stiff legged and slows down the walking pace. All these factors allow our patients to full weight bear and to protect the surgery while they are recovering.
You will usually spend an hour in the recovery room and then a family member or friend can drive you home. Ice and elevation are very important immediately following foot surgery. I advise a couple of pillows under your leg as you lie on the couch or in your bed. It is ideal for your foot to be raised slightly above your heart. With the leg elevated I advise a cold pack or bag of ice directly on the top of the foot ( 20 minutes on and 20 minutes off). I usually allow ambulation in the post-op shoe 5 minutes out of each hour. Use this time to get a bite to eat or to use the bathroom, otherwise, you really need to ice and elevate the foot. This in turn significantly helps reduce post operative edema (swelling) and in turn significantly decreases post-operative discomfort. This is a typical scenario for the first two or three days after surgery and then more ambulation is allowed and less ice and elevation is required. Most of the time a post-operative antibiotic is prescribed for a few days and a pain medication is utilized for 1 to 5 days. If you use a pain medication any longer than this, I would be surprised.
At Professional Foot & Ankle Centers we pride ourselves on our post-operative follow up care. The first visit back to the office is typically in 5 days. During this visit the sterile bandage is changed and the surgical site is inspected by the surgeon. It is very important that the actual surgeon is treating you during your post-operative visits. We are very active with training surgical residents and take great pride in our post-operative outcomes. This starts with your initial visit back to the office. An x-ray is also taken during the first post-operative visit. This is to ensure that everything looks exactly as it did during surgery. Many times a fracture boot is dispensed during this visit. This is used to replace the post-op shoe. The fracture boot provides more stability and is easier to walk in as you will be more mobile at this point. During this visit we are also inquiring about any discomfort. Most people have completely discontinued the use of any pain medication at this point and sometimes an anti-inflammatory medication is prescribed for mild discomfort or swelling. Ice and elevation is less important at this point but still beneficial. It is important to keep your bandage clean, dry and intact until your next visit which will be 1 week later. During your second post-operative visit (12 days after surgery) the sterile bandage is removed and any sutures are removed. Many times we can use all dissolvable sutures but it does depend upon the specific surgical procedure. Most of the time, another x-ray is not required again at this point. You will be able to get your foot wet in the shower for the first time at this point (every patient's favorite day!) An ACE bandage is usually continued with the fracture boot or post-op shoe. Depending upon the procedure listed above a second x-ray may be needed at 4 to 5 weeks to assure appropriate bone healing before a tennis shoe is worn. With other procedures a tennis shoe can be attempted at 2 to 3 weeks after the procedure. Occasionally Physical Therapy is necessary. We pay special attention to bring back strength, motion, and flexibility after the procedure.
FOOT FRACTURES, FUSIONS,
& UNIQUE BUNIONECTOMIES
Great Toe Joint Arthrodesis (Fusion)
Base Wedge Bunionectomy
Metatarsal & Digital Fracture Repair
These procedures are handled very similar to the forefoot procedures. The largest difference is the need for non-weight bearing. Our standard protocol includes non-weight bearing in a cast or fracture boot for 4-6 weeks. During this period in time the use of crutches or a Roll-About or a walker or a wheel chair is necessary. In office x-rays are taken to determine if weight bearing in a fracture boot can begin. There is usually a period of 2 weeks with weight bearing and ambulation in a fracture boot before a tennis shoe is worn.
Lisfranc Fractures (tarsometatarsal fractures)
Subtalar Joint Fusion
Brostrum Procedure / Ankle Stabilization
Repair of Ankle Osteochondral Defect (Talar Dome Lesion)
Peroneal, Posterior Tibial, or Achilles Tendon Repair
Retrocalcaneal Exostectomy with Re-implantation of Achilles Tendon
Flat Foot Reconstruction
Achilles Tendon Lengthening / Repair
This group of procedures typically requires 6-10 weeks of non-weight bearing followed by partial weight bearing and then full weight bearing in a cast or fracture boot.
Endoscopic Plantar Fasciotomy